Is your spiky ball or foam roller as effective as a sports massage?

The sadistic foam roller has firmly asserted a place for itself in the exercising community. Coaches, physiotherapists and athletes all recommend using foam roller massage to increase muscle length and help recovery from exercise. I frequently advise my online physio patients to use foam roller massage for self-treatment and have experienced its effects first-hand (or so I think). The puzzling thing about it is that I still get patients in my physiotherapy practice who complain of stiff/tight muscles, despite the fact that they have stretched and foam rolled the poor muscle to near extinction.

This made me wonder whether foam rolling is really as effective as I and many others claim, or whether we have succumbed to a powerful placebo effect. Why would it be effective for some and not for others?

To answer this question I decided to gather up all the available research on foam rolling and self-myofascial release involving equipment like balls etc. and weigh it up against the available evidence for regular massage.

I found 11 studies looking at the effect of foam rolling on various aspects that may influence performance e.g. muscle strength, jump performance, speed, agility, throwing velocity and accuracy. While none of these studies showed a positive effect on performance, it is important to note that neither did they find that foam rolling caused any decrease in performance.

This may mean that you can safely use a foam roller shortly before you compete, but that it would likely not improve your performance.

It is further important to say that none of these studies received a high quality rating when I reviewed them (see end of article) using the Cochrane Collaboration’s guidelines and their results really need to be viewed with caution until they are confirmed through high quality research.

The quote above also claims that massage can provide you with “high mental clarity to improve your performance”. This is usually derived from the fact that all athletes have a pre-performance routine that they use to get them focused and in the zone. Looking at the research above, I would advocate that foam rolling is a safer option to include as part of your pre-performance routine.

Post-event foam rolling vs. massage

But what about after you've competed? Can massage or foam rolling help you recover quicker from exercise?

Most studies that investigated this question looked at the effects massage and foam rolling can have on Delayed Onset Muscle Soreness (DOMS). DOMS develops after a bout of unaccustomed exercise that usually involves eccentric muscle contractions. The symptoms start between 12-24 hours after exercise, peak around 48 hours and can take up to 10 days to resolve. The athlete usually experiences a marked increase in muscle pain and a decreased ability to produce force.

There is strong evidence that sports massage, performed shortly after exercise, can decrease the pain that a person experiences with DOMS.

There is also some evidence that a post-race massage can lead to improved muscle strength one hour after the event, but not at 24, 48 or 72 hours after the event, when compared to no massage. Massage may thus be an important recovery tool for athletes between races, to help their muscles recover faster in the short term, but is unlikely to add any extra benefit in terms of muscle function in the days following the event.

I could only find 2 studies that investigated the effects of foam rolling on DOMS. MacDonald et al. (2014) received a moderate quality rating but Pearcey et al. (2012) could not be rated as their article is still in print. The results appear to be supportive of the use of foam rolling as a recovery tool after exercise.

Both studies reported a decrease in pain levels due to foam rolling. McDonald et al. (2014) also reported improved recovery for muscle strength and jump performance after foam rolling at 24 and 48 hours post-exercise, while Pearcey et al. (2012) did not consistently observe this across all test days. These results are encouraging but more research is required before a definitive judgement can be made.

One should also not underestimate the psychological effect a massage may have on an athlete. Moraska (2005) rightly points out that not all aspects of success in sport involves muscle function. Tactics, mind games and belief can also determine success. And there is some evidence that massage can positively influence the perception of fatigue and recovery when performed between bouts of exercise. There is currently no research available that investigate the psychological effects of foam rolling.

Maintenance foam rolling vs. massage

I did not find any research for either foam rolling or massage that indicated that you require either modality on a regular basis to stay injury free.

I cringe when I hear therapists (of any kind) tell people that they require regular maintenance to prevent their bodies from breaking down or going “out of alignment”. Yes, you may find that regular massage relieves your neck pain, which is caused by you sitting for hours in front of a computer.

Guess what, life style changes e.g. taking regular breaks or exercise will do that too. AND lifestyle changes may actually prevent the injury from coming back, when massage only provides temporary relief. As a physiotherapist, I always explain this to my patients and an important part of my treatment includes identifying and addressing the aggravating factors for their pain or injury.

OK, rant over. Let’s move on to the next part.

Treatment of injuries with massage or foam rolling

While lots of noise is currently being made about the fact that regular stretching does not prevent injury, it is also true that athletes do require a minimum range of motion to compete in certain sports. From clinical experience I also know that a person can sometimes develop excessive tightness/tone in certain muscles or joints when injured, which has to be addressed if they want to return to full function e.g. stiff ankle joint or calf muscle after a bad ankle sprain.

The studies that have looked at the effects of massage on muscle length have so far reported conflicting results and more research is needed on this topic.

There is some evidence that foam rolling can increase muscle length, but once again the evidence that support this should be viewed with caution due to the big risk of bias in the studies’ design.

With regards to the treatment of specific injuries: Van den Dolder et al. (2014), in their review of the literature, found low-quality evidence that soft tissue massage was effective for producing moderate improvements for people with non-specific shoulder pain, in active ﬂexion and abduction range of motion, pain and functional scores compared with no treatment. Kumar et al. (2013) also found weak evidence that massage may be more effective than placebo for the treatment of non-specific lower back pain.

There is currently no research available that look at the effect of foam rolling on the treatment of injuries.

Why does massage or foam rolling sometimes not work?

Looking at the results above, one may think that it paints a rather gloomy picture for sports massage as well as self-myofascial release (via foam rollers, spiky balls etc.), but that’s not really true. It rather points to a lack of high quality research in these areas.

The good news is that it does suggest that using a foam roller or spiky ball for self-massage can at least be as effective, if not more effective, as a sports massage from your physiotherapist or massage therapist.

But, what about the question that sparked this blog post? Why do people sometimes find foam rolling to be ineffective? The answer may lie in the reason why their muscles are tight/in tone.

It all comes down to having the correct diagnosis. You have to ask "Why are my muscles tight and sore?". If you don't address the cause, your muscles won't relax. Some of the common reasons for persistent muscle tightness or discomfort I see in clinic include increased neural tension (when your nerves aren't free to slide) and overtraining (you've not given your muscles enough time to recover between bouts of exercise).

It is well worth consulting a physiotherapist if you are struggling with persistent muscle tightness. This is something that can easily be done via an online physio consultation and I can provide you with a tailored treatment programme that will help you fix the cause not just the symptoms.